Coronary revascularization: PCI – Coronary revascularization: CABG
Coronary revascularization: PCI Monitor for recurrent angina Frequent VS, including cardiac rhythm Monitor catheter insertion site for bleeding Neurovascular assessment Bed rest per institutional policy Coronary revascularization: CABG ICU for first 24–36 hours Pulmonary artery catheter Intra-arterial line Pleural/mediastinal chest tubes Continuous ECG ET tube with mechanical ventilation Epicardial pacing wires Urinary catheter NG tube […]
Nursing diagnoses : Decreased cardiac output
Nursing diagnoses Decreased cardiac output related to altered contractility and altered heart rate and rhythm Acute pain related to an imbalance between myocardial O2 supply and demand Anxiety related to perceived or actual threat of death, pain, and/or possible lifestyle changes Activity intolerance related to general weakness secondary to decreased cardiac output and poor lung […]
Acute coronary syndrome : Nursing management
Nursing management Nursing Assessment: Subjective Data Health history CAD/chest pain/angina/ MI Valve disease Heart failure/cardiomyopathy, Hypertension, diabetes, anemia, lung disease, hyperlipidemia Drugs Use of anti-platelets or anticoagulants Nitrates Angiotensin-converting enzyme inhibitors β-blockers Calcium channel blockers Antihypertensive drugs Lipid-lowering drugs Over-the-counter drugs (e.g., vitamin and herbal supplements) History of present illness Description of events related to […]
Acute coronary syndrome
Acute coronary syndrome Minimally invasive direct coronary artery bypass (MIDCAB) For patients with disease of left anterior descending or right coronary artery Does not involve a sternotomy and CPB Off-pump coronary artery bypass (OPCAB) Sternotomy but no CPB Robotic or totally endoscopic coronary artery bypass (TECAB) Transmyocardial laser revascularization Indirect revascularization High-energy laser creates channels […]
Interprofessional care : Acute Coronary Syndrome
Interprofessional care Acute Coronary Syndrome Initial interventions 12-lead ECG Upright position Oxygen – keep O2 sat > 93% IV access Nitroglycerin (SL) and ASA (chewable) Statin Morphine Ongoing monitoring Treat dysrhythmias Frequent vital sign monitoring Bed rest/limited activity for 12–24 hours UA or NSTEMI Dual antiplatelet therapy and heparin Cardiac catheterization with PCI once stable […]
Nursing management : Hypertension
Nursing management Nursing Assessment Subjective Data Important Health Information Past health history: Known duration and past workup of high BP; cardiovascular, cerebrovascular, renal, or thyroid disease; diabetes mellitus; pituitary disorders; obesity; dyslipidemia; menopause or hormone replacement status Medications: Use of any prescription or over-the-counter, illicit, or herbal drugs or products; previous use of antihypertensive drug […]
Hypertension in older persons
Hypertension in older persons BP goal for people > 60 is < 150/90 Preferred antihypertensive drugs Thiazide diuretic Calcium channel blockers ACE inhibitors or ARBs Caution use of NSAIDS Hypertensive crisis SBP >180 mmHg and/or DBP >110 mmHg Hypertensive urgency Develops over hours to days May not require hospitalization Hypertensive emergency Very severe problems can […]
Hypertension : Nursing diagnoses
Nursing diagnoses Ineffective health management related to lack of knowledge of pathology, complications, and management of hypertension Anxiety related to complexity of management regimen Sexual dysfunction related to side effects of antihypertensive medication Risk for decreased cardiac tissue perfusion Risk for ineffective cerebral tissue perfusion Risk for ineffective renal perfusion Potential complication: stroke, MI Planning […]
Resistant hypertension
Resistant hypertension Failure to reach goal BP in patients taking full doses of an appropriate 3-drug therapy regimen that includes a diuretic. Reasons include Improper BP measurement Drug-induced Nonadherence (e.g., due to drug side effects, finances) Illegal drugs (e.g., cocaine, amphetamines) Inadequate drug dosages Inappropriate combinations of drug therapy Nonsteroidal anti-inflammatory drugs Sympathomimetics (e.g., decongestants, […]
Hypertension medication : Angiotensin Inhibitors – Calcium Channel Blockers
Angiotensin Inhibitors Angiotensin-Converting Enzyme Inhibitors Benazepril (Lotensin) Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Inhibit ACE, reduce conversion of angiotensin I to angiotensin II (A-II). Inhibit A-II–mediated vasoconstriction. Aspirin and NSAIDs may reduce drug effectiveness. Addition of diuretic enhances drug effect. Should not be used with […]